This is not a surprise: the health system in Quebec, Ontario and elsewhere in the country was fragile long before the pandemic. But seven waves of infections in two years have exacerbated the situation.
Dr. Judy Morris thinks the public does not know how difficult the situation is in the health care system, particularly in the emergency room.: “Emergencies have always been overflowing”. But it is a critical situation. It’s worse than before”,”text”:”I think there is desensitization; people say to themselves: “Emergencies have always been overflowing”. But it is a critical situation. It’s worse than before”}}”>I think there is a desensitization; people say to themselves: “Emergencies have always been overflowing”. But it is a critical situation. It’s worse than beforeshe says, lamenting that the public seems more concerned about queues at passport offices than queues in the emergency room.
<q data-attributes="{"lang":{"value":"fr","label":"Français"},"value":{"html":"Oui, le système est en difficulté depuis 20-30year. But the pandemic has accelerated the deterioration of the health system”,”text”:”Yes, the system has been in trouble for 20-30 years. But the pandemic has accelerated the deterioration of the health system”}}”>Yes, the system has been in trouble for 20-30 years. But the pandemic has accelerated the deterioration of the health systemadds Dr. Katherine Smart, president of the Canadian Medical Association (CMA).
The situation is becoming increasingly untenable and the more waves there are, the faster Canada’s health care system will crumble, she says.
The health system is at the end of its tether, if it is not already [sous] artificial respirator. If we are not serious and we do not take the necessary measures to [aborder] the challenges, we will end up with a code blue situation in the coming years
adds Paul-Émile Cloutier, President and CEO of HealthCareCAN, an organization that represents research hospitals, health centers and health organizations across the country.
At the speed with which the system is falling apart, the reality is far different from previous crises, says Damien Contandriopoulos, a professor at the University of Victoria’s School of Nursing and a public health policy expert.
And no, he insists, the pressure on the health care system caused by the pandemic cannot be said to be of the same magnitude as during a flu season.
« The flu was a rather long wave each winter. But there, it’s the same thing, but bionic version, year-round. »
Curbing COVID-19 to help the system
While the pandemic has exposed the flaws in the system, Dr Morris sayswe no longer have the capacity to live with other overflows
.
The system was not designed to cope with such continuous pressure, adds Paul-Émile Cloutier.
The more the virus circulates, the more healthcare workers become infected and have to isolate themselves, which exacerbates the workforce problem, adds Dr. Smart. Each more stress, each more wave pushes the system even more towards failure. The healthcare system is no longer able to handle waves again and again.
For example, as of July 15, in Quebec, there are more than 7,000 health care workers absent due to COVID-19. If this is less than the 20,000 absentees in January 2022, it should be remembered that the Quebec Minister of Health, Christian Dubé, affirmed in December 2021, when there were 7,000 absentees, that the province has a societal issue. We have more and more patients, but fewer and fewer people to treat them
.
Even during the lulls between the waves, there were always more than 3,000 absent Quebec workers.
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The question that haunts these experts: what wave will be the deathblow for the health system?
This is why they are of the opinion that, in order to help the healthcare system survive, it must first and foremost reduce the transmission of SARS-CoV-2.
We need a credible COVID-19 exit scenario. We were sold the “epidemiologically” wacky scenario that it’s the last wave and it’s over
denounces Mr. Contandriopoulos, who is not very optimistic for the coming months, especially if governments do not intervene.
« We decided that we no longer wanted to wear masks, even if it is a very effective measure. But can we afford not to do it when the hospitals are cracking up? »
Judy Morris, President of the Quebec Association of Emergency Physicians
Photo: University of Montreal
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According to Dr. Judy Morris, president of the Association of Emergency Physicians of Quebec, if we choose not to put in place certain sanitary measures, we will have to massively
health workers.
A labor shortage that is growing from wave to wave
It is still necessary to be able to find these workers, in a context of shortage and professional exhaustion.
There is an extremely high number of workers who have worked tirelessly for two years, who have taken care of a large volume of patients. They are burned
, says Dr. Smart, adding that more and more people are leaving the healthcare field. These workers are sick of being in a broken system, she says.
She said that in the first quarter of 2022, there were nearly 137,000 vacancies in the health field across Canada, a record high. If the trend continues, it is obvious that there will be a break.
But this rupture is already being felt. According to Dr. Smart, ER wait times across the country are at their highest level in 14 years; one in seven Canadians does not have a family doctor. And that’s not counting the surgery waiting lists that keep getting longer.
At the beginning of June, Quebec’s chief medical officers sounded the alarm: in a letter, they expressed their concerns about not being able to provide safe services for the summer period. Six emergency services will be partially closed this summer in Quebec due to staff shortages.
In Ontario, several regional ERs will also be closed. Same scenario in New Brunswick, Alberta, Manitoba, Newfoundland and Labrador and British Columbia.
This is a very worrying situation for these communities
says Mr. Cloutier, who fears that these closings will occur more frequently or become permanent.
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Emergency departments in hospitals in Newfoundland and Labrador regularly experience service interruptions.
Photo : Jeremy Eaton/CBC
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Dr. Smart worries when she hears more and more heartbreaking stories from Canadians who don’t have access to proper care. She cites the death of a patient in the waiting room of a New Brunswick emergency department or that of a 91-year-old Montrealer who died on her balcony after waiting for an ambulance for 7 hours.
« They are no longer single stories. It is reality. What that means is that primary care as we know it and expect it to be is slowly dying. »
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Canadian Medical Association President Katherine Smart
Photo: Courtesy: Canadian Medical Association
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Money is not the silver bullet
This week, provincial and territorial premiers, gathered at the Council of the Federation, demanded that Ottawa substantially increase its share of health care costs.
But according to Mr. Cloutier, Dr. Morris, Dr. Smart, Mr. Cloutier and Mr. Contandriopoulos, the solution to the problem is not necessarily more money.
It’s a bit sad to see this spectacle of premiers blaming federal funding for health problems and the federal government promising money, but only on certain conditions
, laments Mr. Contandriopoulos. Having more money without a concrete plan will not fix the situation, he says.
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Damien Contandriopoulos, professor at the School of Nursing at the University of Victoria and holder of the Research Chair in Canadian Policy, Knowledge and Health.
Photo : Radio-Canada/Claude Brunet
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Dr. Smart agrees. Nobody has the courage to tackle a change in the system and we dare not adopt innovative solutions. This is the fundamental problem and this is why we do not see any changes.
If a complete overhaul of health care systems in Canada is necessary, the first priority is to tackle the retention of the workforce.
<q data-attributes="{"lang":{"value":"fr","label":"Français"},"value":{"html":"Il faut que les politiciens arrivent avec un plan dans lequel les travailleurs voient une lumière au bout du tunnel, dit M.Contandriopoulos. Otherwise, the labor haemorrhage will not stop. People don’t want to wait their entire careers to see change.”,”text”:”Politicians need to come up with a plan in which workers see a light at the end of the tunnel, says Contandriopoulos. Otherwise, the labor haemorrhage will not stop. People don’t want to wait their whole career to see changes.”}}”>Politicians need to come up with a plan in which workers see a light at the end of the tunnel, says Contandriopoulos. Otherwise, the labor haemorrhage will not stop. People don’t want to wait their whole career to see changes.
Several organizations and associations representing health care workers are proposing various measures to begin this overhaul of the health care system, such as the following:
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harmonize the issuance of licenses to practice across the country, to allow for better labor mobility;
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simplify the requalification of foreign workers;
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encourage universities to graduate more people in areas with labor shortages;
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having better national workforce data;
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reorganize the structure of primary care;
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reduce the administrative burden on physicians.
While the task may seem daunting and insurmountable, Dr. Smart believes the pandemic has shown that it is possible for the healthcare system to transform rapidly. For example, before the pandemic, there was almost no telemedicine in Canada. And almost overnight, we pivoted to online dating. So it is possible to make things happen when we work together.
Even though it is one to midnight, Dr. Smart remains hopeful that governments will act in time. The alternative is the complete collapse of the healthcare system.
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